IEP/504 Empowerment Course Sign-up – Building Connections

Participate Name: *

Email *

Phone Number: *

Which course will you be attending? *

Fall: Friday August 29th 5pm-8pm
Spring-Friday March 6th 5pm-8pm

How will you be attending the IEP/504 Empowerment course? *

Online/Virtual (link will be emailed day of event)
In-person at the farm Address: 7408 Halifax Rd. Youngsville, NC

Which course child’s

Child Name: *

Current grade and School they attend: *

Does your child have a 504 or IEP? *

How long has your child had an IEP or 504?

If it is your first time going through the process, have you started the process and if you have where are you in the process?

Current Supports: Do you have a team that is supporting your child outside of school?

If yes, please list their roles (ex: neurologist, counselor, pediatrician, tutor, etc)

What are your main concerns about your child’s school supports?

How would you describe your relationship with your child’s school?

What are you hoping to get from this course?

If you will be joining us at the farm have you completed our liability forms? *

If your family has not yet completed our liability forms, please use the link below to do so. Everyone in your party must be listed on the form. If you’ve already submitted a liability form for your child through our social skills group, or if you've completed one for a previous event that includes all attendees for this event, there’s no need to fill out another.

Click here to complete the Liability forms

Number of tickets you would like to purchase: *

$175.00/person

Total

$0.00

I understand that that refunds will only be provided in the event of a cancellation by Building Connections staff. *

Stripe Credit Card *